Rural people who inject drugs: A cross-sectional survey addressing the dimensions of access to secondary needle and syringe program outlets.

OBJECTIVE: To better understand issues related to access to injecting equipment for people who inject drugs (PWID) in a rural area of New South Wales (NSW), Australia. DESIGN: Cross-sectional face-to-face survey using convenience and snowball sampling. SETTING: Six regional and rural population centres in Northern NSW, within the Hunter New England Local Health District. PARTICIPANTS: The sample included 190 PWID who had accessed a needle and syringe program outlet within 4 weeks of the survey. MAIN OUTCOME MEASURES: Data include demographic information, preferred location for accessing injecting equipment, reasons for that preference, whether they obtained enough equipment, travelling distance to an NSP and self-reported hepatitis C virus status. RESULTS: Sixty percent self-identified as Aboriginal people. The median age of respondents was 32 years and 60% were men. A significantly larger proportion (P < 0.05) of the Aboriginal respondents were women (27% versus 11.6%) and younger (37.6 versus 12.7%) compared to non-Aboriginal respondents. Most preferred to access injecting equipment at a community health facility (62.6%), as opposed to other secondary outlets, where they gained enough equipment (67.4%). Just over 80% said they were tested for HCV in the past year, with about 37% told they had tested positive. CONCLUSIONS: There are complex dimensions affecting how rural PWID access secondary NSP outlets. Although access is similarly limited as other rural health services because of the nature of injecting drug use and sensitivities existing in rural communities, there is potential for application of unique access models, such as, promoting secondary distribution networks.

Evaluating the economic loss of caregiving for palliative care patients.

OBJECTIVE: Our aim is to provide a unified measure of the economic burden faced by families during the palliative phase of care and to compare this measure to Statistics Canada's low-income cut-off. METHODS: Samples of palliative care patients living at home and their main informal caregivers were recruited in five Canadian urban regions. Interviews were performed every two weeks until the patient's passing, up to a maximum of six months. Participants were asked to provide details about their expenses and their absences from work that related specifically to the patient's condition. Income loss was evaluated for 192 family units. RESULTS: About 9 percent of families incurred economic losses in excess of 10 percent of their pre-study gross annual income; low-income status increased from 27 (before) to 40 (after). CONCLUSION: This is the first study to provide a unified measure of economic losses of caregiving that can be related to a publicly designated low-income threshold.

A rat subchronic study transcriptional point of departure estimates a carcinogenicity study apical point of departure.

Considerations of human relevance and animal use are driving research to identify new approaches to inform risk assessment of chemicals and replace guideline-based rodent carcinogenicity tests. Here, the hypothesis was tested across four agrochemicals that 1) a rat 90-day transcriptome-based BEPOD is protective of a rat carcinogenicity study and 2) a subchronic liver or kidney BEPOD would approximate a cancer bioassay apical POD derived from other organs and a rat subchronic BEPOD would approximate a mouse cancer bioassay apical POD. Using RNA sequencing and BMDExpress software, liver and/or kidney BEPOD values were generated in male rats exposed for 90 days to either Triclopyr Acid, Pronamide, Sulfoxaflor, or Fenpicoxamid. BEPOD values were compared to benchmark dose-derived apical POD values generated from rat 90-day and rodent carcinogenicity studies. Across all four agrochemicals, findings showed that a rat 90-day study BEPOD approximated the most sensitive apical POD (within 10-fold) generated from the 90-day rat study and long-term rodent carcinogenicity studies. This study supports the conclusion that a subchronic transcriptome-based BEPOD could be utilized to estimate an apical POD within a risk-based approach of chronic toxicity and carcinogenicity agrochemical assessment, abrogating the need for time- and resource-intensive rodent carcinogenicity studies and minimizing animal testing.

The trajectory of palliative care costs over the last 5 months of life: a Canadian longitudinal study.

OBJECTIVE: This study aimed to highlight the trajectory of palliative care costs over the last five months of life in five urban centres across Canada. SUBJECTS: The study sample was comprised of 160 terminally ill patients and their main informal caregivers. RESEARCH DESIGN: A first interview took place in the patient's home, and subsequent follow-up interviews were conducted by telephone at two week intervals until the patient's passing. MEASURES: Participants were asked to provide information on the goods and services they used related to the patients' health condition, and on informal caregiving time. RESULTS: The overall costs of care gradually increased from the fifth to the last month of the patients' life. A large part of this cost increase was attributable to inpatient care. Among outpatient care costs the largest increase was observed for home care. Informal care costs were particularly high over the last 3 months of life. CONCLUSIONS: The knowledge gained from this study would be useful to policy makers when developing policies that could help families caring for a terminally ill loved one at home.

Costs associated with resource utilization during the palliative phase of care: a Canadian perspective.

OBJECTIVE: This study aimed to evaluate prospectively the resource utilization and related costs during the palliative phase of care in five regions across Canada. SUBJECTS: A cohort of 248 patients registered in a palliative care program and their main informal caregivers were consecutively recruited. RESEARCH DESIGN: A prospective research design with repeated measures was adopted. Interviews were conducted at two-week intervals until the patient s passing or up to a maximum of 6 months. MEASURES: The survey questions prompted participants to provide information on the types and number of goods and services they used, and who paid for these goods and services. RESULTS: The largest cost component for study participants was inpatient hospital care stays, followed by home care and informal caregiving time. In regard to cost sharing, the public health care system (PHCS), the family, and not-for-profit organizations (NFPO) sustained respectively 71.3%, 26.6%, and 1.6% of the mean total cost per patient. CONCLUSION: Such results provide a comprehensive picture of costs related to palliative care in Canada, by specifying the cost sharing between the PHCS, the family, and NFPO.

Impact of a national campaign on hospital readmissions in home care patients.

OBJECTIVE: Assess impact of nationwide home health quality improvement campaign to reduce acute care hospitalization of home health recipients. DESIGN: Observational pre-post comparison of self-selected participating and non-participating agencies' quality performance; survey to determine uptake of program materials. SETTING: US home health care agencies. PARTICIPANTS: A total of 147 agencies with 147 non-participating agencies matched on patient length of service, pre-intervention hospitalization rate and pre-intervention rate of change in hospitalization rate. INTERVENTION(S): Public events; provision of educational packages and technical assistance; quality measure feedback. MAIN OUTCOME MEASURE(S): Post-intervention difference in risk-adjusted acute care hospitalization rate between participants and non-participants; difference in self-reported campaign material use between agencies whose hospitalization rate declined 2% or more and those whose rates increased by 2% or more. RESULTS: Hospitalization rate had a negative trend beginning before the campaign. In the matched pairs studied, it did not differ significantly between participants and non-participants, or from pre- to post-intervention period (28% in every case). Agencies that improved were more likely to report activities consistent with the campaign and using campaign interventions than those not improving (P < 0.001), regardless of participation status. CONCLUSIONS: Merely agreeing to participate in the campaign did not improve performance, but effective participation through adoption of campaign methods did.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada.

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

The personal costs of caring for a child with a disability: a review of the literature.

This article presents a review of the literature published from 1989 to 2005 for articles that examined the economic burden incurred by families as a result of caring for a child with disabilities. The review was performed according to a comprehensive economic conceptual model developed by the authors and to the guidelines set out by Canadian Coordinating Office for Health Technology Assessment. The analysis indicated that the burden incurred by these families can be substantial, especially among families who care for a child with a severe disability. However, the variability and the quality of methods is such that the return on investment in knowledge of costs in this area is not as high as it could have been had methodological procedures been more standardized. A comprehensive and systematic approach is suggested for future research.

Resources for health promotion: rhetoric, research and reality.

BACKGROUND: Canadian political discourse supports the importance of health promotion and advocates the allocation of health resources to health promotion. Furthermore, the current literature frequently identifies financial and human resources as important elements of organizational capacity for health promotion. In the Alberta Heart Health Project (AHHP), we sought to learn if the allocation of health resources in a regionalized health system was congruent with the espoused support for health promotion in Alberta, Canada. METHODS: The AHHP used a mixed method approach in a time series design. Participants were drawn from multiple organizational levels (i.e., service providers, managers, board members) across all Regional Health Authorities (RHAs). Data were triangulated through multiple collection methods, primarily an organizational capacity survey, analysis of organizational documents, focus groups, and personal interviews. Analysis techniques were drawn from quantitative (i.e., frequency distributions, ANOVAs) and qualitative (i.e., content and thematic analysis) approaches. RESULTS: In most cases, small amounts (<5%) of financial resources were allocated to health promotion in RHAs' core budgets. Respondents reported seeking multiple sources of public health financing to support their health promotion initiatives. Human resources for health promotion were characterized by fragmented responsibilities and short-term work. Furthermore, valuable human resources were consumed in ongoing searches for funding that typically covered short time periods. CONCLUSIONS: Resource allocations to health promotion in Alberta RHAs are inconsistent with the current emphasis on health promotion as an organizational priority. Inadequate and unstable funding erodes the RHAs' capacity for health promotion. Sustainable health promotion calls for the assured allocation of adequate, sustainable financial resources.

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.

A fully human monoclonal antibody to the insulin-like growth factor I receptor blocks ligand-dependent signaling and inhibits human tumor growth in vivo.

The insulin-like growth factor I receptor (IGF-IR) is overexpressed in many diverse tumor types and is a critical signaling molecule for tumor cell proliferation and survival. Therapeutic strategies targeting the IGF-IR may therefore be effective broad-spectrum anticancer agents. Through screening of a Fab phage display library, we have generated a fully human antibody (A12) that binds to the IGF-IR with high affinity (4.11 x 10(-11) M) and inhibits ligand binding with an IC(50) of 0.6-1 nM. Antibody-mediated blockade of ligand binding to the IGF-IR inhibited downstream signaling of the two major insulin-like growth factor (IGF) pathways, mitogen-activated protein kinase and phosphatidylinositol 3'-kinase/Akt, in MCF7 human breast cancer cells. As a result, the mitogenic and proliferative potential of IGF-I and IGF-II were significantly reduced. A12 did not block insulin binding to the insulin receptor but could block binding to atypical IGF-IR in MCF7 cells. In addition, A12 was shown to induce IGF-IR internalization and degradation on specific binding to tumor cells, resulting in a significant reduction in cell surface receptor density. In xenograft tumor models in vivo, IGF-IR blockade by A12 was shown to occur rapidly, resulting in significant growth inhibition of breast, renal, and pancreatic tumors. Histological analysis of tumor sections demonstrated a marked increase in apoptotic tumor cells in antibody-treated animals. These results demonstrate that A12 possesses strong antitumor activity in vitro and in vivo and may therefore be an effective therapeutic candidate for the treatment of cancers that are dependent on IGF-IR signaling for growth and survival.

Identifying factors associated with regular physical activity in leisure time among Canadian adolescents.

PURPOSE: The purpose of this study was to identify the factors explaining regular physical activity among Canadian adolescents. DESIGN: A cohort study conducted over a period of 2 years. SETTING: A French-language high school located near Québec City. SUBJECTS: A cohort of 740 students (352 girls; 388 boys) aged 13.3 +/- 1.0 years at baseline. MEASURES: Psychosocial, life context, profile, and sociodemographic variables were assessed at baseline and 1 and 2 years after baseline. Exercising almost every day during leisure time at each measurement time was the dependent variable. RESULTS: The Generalized Estimating Equations (GEE) analysis indicated that exercising almost every day was significantly associated with a high intention to exercise (odds ratio [OR]: 8.33, confidence interval [CI] 95%: 5.26, 13.18), being satisfied with the activity practiced (OR: 2.07, CI 95%: 1.27, 3.38), perceived descriptive norm (OR: 1.82, CI 95%: 1.41, 2.35), being a boy (OR: 1.83, CI 95%: 1.37, 2.46), practicing "competitive" activities (OR: 1.80, CI 95%: 1.37, 2.36), eating a healthy breakfast (OR: 1.68, CI 95%: 1.09, 2.60), and normative beliefs (OR: 1.48, CI 95%: 1.14, 1.90). Specific GEE analysis for gender indicated slight but significant differences. CONCLUSIONS: This study provides evidence for the need to design interventions that are gender specific and that focus on increasing intention to exercise regularly.

[French-Canadian validation of the MOS Social Support Survey]. / Validation canadienne-francaise du "MOS Social Support Survey".

BACKGROUND: The MOS Social Support Survey was developed for patients who participated in the Medical Outcomes Study (MOS), a two-year study on persons who suffered from chronic illness. There are a number of advantages to using the MOS Social Support Survey, especially with those persons who suffer from chronic illness: it is easy to understand, is relatively short, is multidimensional, can be completed by the patient without assistance and has good psychometric properties. OBJECTIVE: The goal of this study was to establish a French-Canadian version of the MOS Social Support Survey and to verify its psychometric properties following the cross-cultural translation and validation procedures proposed by Vallerand. METHODS: A first draft of the MOS Social Support Survey was achieved by following the back-to-back translation technique. Next, a committee of four bilingual people reviewed and evaluated the preliminary versions of the questionnaire (English and French) to establish a French experimental version. A pre-test was done with 10 francophone persons. The Haccoun method was used to evaluate the construct validity and test-retest reliability, as well as the internal consistency of the questionnaire. The test-retest was performed with 20 students from the School of Languages from Laval University, Sainte-Foy, Quebec. The present research was approved by the ethics committee of the institution. RESULTS: The results showed acceptable internal consistency and good reliability. The psychometric properties were found to be acceptable and comparable with those obtained by Sherbourne and Stewart with the English version. CONCLUSION: The French-Canadian version of the MOS Social Support Survey should be useful in evaluating social support among patients to allow medical staff to plan rehabilitation programs that would include the necessary consultations and interventions needed to establish a better quality of life for the patient.

Development of measures of organizational leadership for health promotion.

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n=144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between .79 and .91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion.

Development of measures of individual leadership for health promotion.

PURPOSE: This purpose of this research was to develop and establish psychometric properties of scales measuring individual leadership for health promotion. DESIGN/METHODOLOGY/APPROACH: Scales to measure leadership in health promotion were drafted based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative (CHHI), and on the literature. Content validity was established through a series of focus groups and expert opinion appraisals and pilot testing. Psychometric analyses provided empirical evidence of the construct validity and reliability of the leadership scales in the baseline survey (n = 144) of the Alberta Heart Health Project. FINDINGS: Principal component analysis verified the construct of the leadership scales of personal work-related practices and satisfaction with work-related practices. Each of the theoretically a prior determined scales factored into two scales each for a total of four final scales. Scale alpha coefficients (Cronbach's alpha) ranged between 0.71 and 0.78, thus establishing good scale internal consistencies. RESEARCH LIMITATIONS/IMPLICATIONS: Limitations include the relatively small sample size used in determining psychometric properties. In addition, further qualitative work would enhance understanding of the complexity of leadership in health organizations. These measures can be used by both researchers and practitioners for the assessment leadership for health promotion and to tailor interventions to increase leadership for health promotion in health organizations. ORIGINALITY/VALUE: Establishing the psychometric properties and quality of leadership measures is an innovative step toward achieving capacity assessment instruments which facilitate evaluation of key relationships in developing health sector capacity for health promotion.

Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program.

The study assessed the impact of health care provider HIV/AIDS education and training on patient care from nine Special Projects of National Significance. Telephone interviews were conducted with 218 health care providers within 8 months, on average, following completion of training. Respondents provided examples of how the SPNS trainings affected their provision of patient/client care. Transcribed comments reflecting change in patient/client care were classified by independent coders under 1 of 10 broad practice change categories. Eighty-two percent of the trainees identified at least one instance of change in patient/client care as a function of their training experience. Self-reported findings included changes in the number/types of patients seen, interpersonal interactions with patients/clients, HIV testing and counseling practices, patient/family education, infection control, advocacy, referrals and collaboration, documentation, and other service changes.

The CDC 2002 guidelines for the treatment of sexually transmitted diseases: implications for women's health care.

Persons rely on health care providers to make diagnostic and therapeutic decisions based on the most current information. With areas of practice changing rapidly, providers are challenged to keep abreast of new and changing treatment guidelines. The new Centers for Disease Control and Prevention (CDC) 2002 Sexually Transmitted Disease (STD) Treatment Guidelines provide clinical guidance in the appropriate assessment and management of STDs. This article reviews recent changes in the STD Treatment Guidelines for the most common disease entities and their sequelae encountered by women's health practitioners. The changes noted in this article include new screening recommendations, use of new diagnostics, new treatment algorithms, and changes in therapeutic regimens.

Gender differences in senior management decision making in the New England Area Health Service.

Data from a questionnaire administered to senior managers in the New England Area Health Service (NEAHS) was used to examine gender differences in decision-making processes. The study found that female managers were more likely to report that they included staff in decision-making processes. The small size of the population restricted the statistical analysis; more meaningful findings may result if the study were to be repeated using a larger population of senior managers.

Self-image differences as related to body image of students in a middle school.

OBJECTIVE: To examine whether gender and ethnic self-image differences exist among Asian and white adolescents within the context of body image. METHODS: One hundred seventy-seven students in a Midwestern US middle school were surveyed on self-image. Analyzed using 2-way ANOVA by gender and race. RESULTS: Asian students have lower self-image compared to white students, including the subcomponents of self-esteem, identity, and integrity. CONCLUSIONS: Asian students have more critical feelings about themselves, base their identities on a few sources rather than on diverse sources, and choose unrealistic standards. However, Asian girls scored better on the image-consciousness subscale.

Measurement challenges of informal caregiving: a novel measurement method applied to a cohort of palliative care patients.

Informal caregiving is a complex concept, and inconsistencies are found in the literature regarding how to measure it. The differences in tasks included in the definition of caregiving, as well as the different methods used to measure caregiving time may explain the huge variations in results found in the literature. The current paper aimed to lay out the challenges of how to calculate the time spent by informal caregivers on providing care and assistance to an ill person at home. It also proposes a method for measuring informal caregiving time, which attempts to distinguish between "normal" activities and "caregiving" activities. The proposed measurement method is then applied to a cohort of informal caregivers of palliative care patients. The illustration study revealed that this method brought advantages comparatively to other methods, and that persisting challenges remain in measuring informal caregiving time. We conclude that, the estimate of time spent caregiving for palliative care patients may be useful in guiding support programs for the families taking care of a loved one at home during the palliative phase of care.